Peptic ulcer as a risk factor for postherpetic neuralgia in adult patients with herpes zoster

Abstract

Postherpetic neuralgia is the most common complication of herpes zoster. Identifying predictors for postherpetic neuralgia may help physicians screen herpes zoster patients at risk of postherpetic neuralgia and undertake preventive strategies. Peptic ulcer has been linked to immunological dysfunctions and malnutrition, both of which are predictors of postherpetic neuralgia. The aim of this retrospective case-control study was to determine whether adult herpes zoster patients with peptic ulcer were at greater risk of postherpetic neuralgia. Adult zoster patients without postherpetic neuralgia and postherpetic neuralgia patients were automatically selected from a medical center's electronic database using herpes zoster/postherpetic neuralgia ICD-9 codes supported with inclusion and exclusion criteria. Consequently, medical record review was performed to validate the diagnostic codes and all pertaining data including peptic ulcer, Helicobacter pylori (H. pylori) infection and ulcerogenic medications. Because no standard pain intensity measurement exists, opioid usage was used as a proxy measurement for moderate to severe pain. In total, 410 zoster patients without postherpetic neuralgia and 115 postherpetic neuralgia patients were included. Multivariate logistic regressions identified 60 years of age and older, peptic ulcer and greater acute herpetic pain as independent predictors for postherpetic neuralgia. Among etiologies of peptic ulcer, H. pylori infection and usage of non-selective nonsteroidal anti-inflammatory drugs were significantly associated with the increased risk of postherpetic neuralgia; conversely, other etiologies were not significantly associated with the postherpetic neuralgia risk. In conclusion, 60 years of age and older, peptic ulcer and greater acute herpetic pain are independent predictors for postherpetic neuralgia in adult herpes zoster patients.

Plasma Vitamin C Concentrations Were Negatively Associated with Tingling, Prickling or Pins and Needles Sensation in Patients with Postherpetic Neuralgia

“…The LANSS Pain Scale published in 2001 was the first screening tool for discriminating neuropathic from nociceptive pain [ 27 ]. Comorbidities including hypertension, diabetes mellitus, cancers, chronic obstructive pulmonary disease, PUD, hypercholesterolemia and dialysis with chronic kidney disease were selected because of their being reported to be associated with an increased risk of HZ and/or PHN [ 35 , 36 , 37 , 38 , 39 ]. Concurrent or pre-existing PUD was defined as having gastroendoscopy-proven PUD within one year prior to the outbreaks of HZ [ 37 , 40 ].…”

Hypovitaminosis D in Postherpetic Neuralgia—High Prevalence and Inverse Association with Pain: A Retrospective Study

“…31, 2016). Inclusion criteria for PHN were (1) International Classification of Diseases, Ninth Revision, Clinical Modification codes (ICD-9) 053 herpes zoster/053.X combined with new prescriptions of an analgesic, an anticonvulsant or an antidepressant for at least 90 days; (2) ICD-9 053.1X (herpes zoster with nervous system complications) [37,38]; and (3) patients with pain clinic visits ≥ 2 times during the study period [37,38]. Exclusion criteria were as follows: (1) patients diagnosed with herpes zoster ICD-9 053 in the preceding years; (2) patients who had diagnostic codes of human immunodeficiency virus infection (ICD-9 042, 043, 044) and organ transplants (ICD-9 3751, 1160, 1164, 1169, 5059, 5280, 5283, 5569, 3350–3352), which are potential confounders of shingles/PHN [21,38] and hypovitaminosis D [39,40]; and (3) patients whose medical records showed no evidence of serum 25(OH)D and VZV IgG/IgM survey during the study period.…”

“…Patients with chronic kidney disease were those who had ICD-9 585 and received dialysis regularly. Helicobacter pylori -related peptic ulcer disease was identified by ICD-9 530–534 and confirmed by positive findings on either hospital gastroduodenoscopy records or a self-reported gastroduodenoscopy history with prescriptions for the disease within one year prior to shingles outbreak [38].…”

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

“…PHN correlates strongly with advancing age [15, 18, 21, 96, 102, 137, 340, 356, 357], the other major prognostic factors being the severity of HZ and intensity of acute pain [23, 99, 137, 356, 357, 360–362]. Comorbid risk factors include diabetes, lymphoma/leukaemia, SLE [137, 363], peptic ulcer disease [364], and micro-nutrient deficiencies [333]. There is also evidence of specific phenotypic [358] and genotypic predispositions [365–368].…”